Treating Doctors for Corruption

BRATISLAVA, Aug 19 2012 (IPS) - Slovak doctors have launched an unprecedented campaign to rid their own profession of what is widely perceived as endemic bribery.

Launching the ‘Thank You, We Don’t Take Bribes’ campaign, officials from the Medical Trade Unions Association (LOZ) said the move would reassure the public of medics’ integrity and increase transparency in the healthcare system.

But experts believe it will do little to stop corruption in the sector.

Roman Muzik, an analyst at the Health Policy Institute (HPI) think-tank in Bratislava, told IPS: “It is an interesting and atypical measure, but it won’t significantly decrease corruption in the healthcare system. More effective measures are needed.”

The campaign – which will see hospital doctors wearing the stickers when treating patients and a special website set up showing which doctors have joined – comes amid a continuing overwhelming public perception of the country’s healthcare sector as having, as in many other Eastern European nations, a serious problem with bribery.

According to a 2010 study by Transparency International, Slovakia’s healthcare system was perceived to be the 18th most corrupt out of 88 countries surveyed. Another study released this year showed one in four families in Slovakia had personal experience of bribery involving a doctor.

Patients often say that even when not directly asked for a bribe, they feel they must offer one to guarantee at least reasonable healthcare.

Interviews with patients have shown that payments of anywhere from tens of euros to thousands of euros are handed in return for priority on operation waiting lists or above-standard service.

The situation is the same, or worse, in other Central and Eastern European (CEE) countries, with healthcare in the Ukraine, Moldova, Romania and Hungary perceived as having particularly severe problems with medical workers taking bribes.

Healthcare in many countries in the region is grossly underfunded compared to the European average and very low pay and poor working conditions – which have caused mass strikes by medical workers in Hungary, the Czech Republic and Slovakia in the last two years – are often cited as reasons for medics taking bribes.

But a recent research paper from HPI has dismissed this, instead suggesting doctors’ greed and the fact that “circumstances allow them” to demand bribes as more likely reasons for flourishing corruption.

A lack of clarity on patient rights and entitlements is also thought to contribute to the problem.

Gabriel Sipos, head of Transparency International Slovakia, told the local Sme newspaper: “It’s important that a basic package is defined showing what a patient is entitled to. If this is not clear, it creates room for ‘under the table’ negotiation.”

But others say that the causes of problems with corrupt doctors are more complex and date back to the communist regimes in place across the region until just over 20 years ago.

Handing over money and gifts in return for preferential treatment or access to certain products and services was regular and a normal way of life at all levels of society.

This created a culture and general acceptance of bribery which remains entrenched in some sectors today.

The World Bank has estimated that, in Romania alone, as much as 750,000 euros per day is received or offered in bribes. Local media have reported that staff at hospitals will demand from hundreds to hundreds of thousands of euros for anything from ensuring bed sheets are changed to approving operations abroad.

Romanian health minister Ladislau Ritli admitted to media earlier this year: “Corruption is so deeply rooted in our system that it’s really difficult to eliminate.”

HPI’s Muzik told IPS: “One of the reasons behind problems with bribery in healthcare is that corruption in general is deeply rooted in people’s behaviour. They used bribes before 1989, under the communist regime, and so they continue to use them now.”

He added that patients themselves also needed to play their part in stamping out bribery.

“Patients need to stop following the idea that ‘everybody is doing it, so why not me?’ and giving bribes.”

Patients have also been called on to make sure they report doctors who ask for bribes and along with its new campaign, LOZ has called for the Health Ministry to set up a special hotline where patients can report bribery.

While some doctors have been caught taking bribes after patients went to the police, prosecutions for corruption in the sector have been rare.

Many patients admit to being reluctant to report medics who demand bribes, fearing what some term as a “white-coat mafia” could do to them on an operating table.

Within the profession, few doctors ever speak openly of corruption or colleagues accepting bribes. But some will admit privately that it is not uncommon.

Sylvia Kucharova*, a psychiatrist from Zilina in northern Slovakia, told IPS that although she did not take bribes she was aware that the practice went on.

She said: “There are plenty of people looking for, and offering, ‘sweeteners’. It’s always been there.”

There is little expectation that the problem is likely to be resolved in the immediate future. But despite the doubts about the overall effectiveness of the campaign, the fact that it has been launched at all is a positive step.

Muzik said: “It has to be said that although the campaign is not likely to have much effect on corruption it is good that Slovak doctors are admitting there is corruption in the system, that they feel it is widespread and that they want to do something about it.”